Critical care therapy use after radical cystectomy in patients with non-metastatic bladder cancer
Carolin Siech, Letizia Maria Ippolita Jannello, Mario de Angelis, Francesco Di Bello, Jordan A. Goyal, Zhe Tian, Fred Saad, Shahrokh F. Shariat, Nicola Longo, Ottavio De Cobelli, Alberto Briganti, Marina Kosiba, Philipp Mandel, Luis A. Kluth, Felix K.‐H. Chun, Pierre I. Karakiewicz
Abstract
To assess critical care therapy use in patients with non-metastatic bladder cancer undergoing radical cystectomy. Using the National Inpatient Sample (2000-2019), we identified non-metastatic bladder cancer patients undergoing radical cystectomy. Study endpoints consisted of critical care therapy use, defined as total parenteral nutrition, invasive mechanical ventilation, dialysis, percutaneous endoscopic gastrostomy tube insertion, tracheostomy, and in-hospital mortality. Estimated annual percentage changes (EAPC) and multivariable logistic regression models were used. Of 25,535 patients, 3,091 (12.1%) received critical care therapy. Critical care therapy use decreased from 13.1 in 2000 to 5.9% in 2019 (EAPC -2.4; p=0.005), and in-hospital mortality also decreased from 3.4 to 0.7% (EAPC -4.2%; p<0.001). Older (≥80 years: odds ratio [OR] 1.91; p<0.001, and 60-79 years OR 1.41; p<0.001) and sicker patients (Charlson comorbidity index [CCI] ≥3: OR 3.16; p<0.001; CCI 1-2 OR 1.89; p<0.001) were more likely to receive critical care therapy. Conversely, minimally-invasive surgical approach (OR 0.66; p=0.01) and teaching hospital status (OR 0.70; p=0.008) independently predicted lower critical care therapy use. The same risk factors were identified for in-hospital mortality. Critical care therapy use in radical cystectomy patients decreased from 13.1 in 2000 to 5.9% in 2019 and so did in-hospital mortality (3.4 to 0.7%). Of all critical care therapy determinants, CCI ≥3 (OR 3.2) represented the strongest followed by octogenarian age (OR 1.9). Even after adjustment for patient age and comorbidities, minimally-invasive surgical approach and teaching hospital status were associated with lower critical care therapy use, and lower in-hospital mortality.